Experts: YUHS a model for health care reform

While debate over national health care reform rages in Washington, administrators at the Yale Health Plan are finding answers close to home.

In interviews, past and present directors of the Yale Health Plan said the University’s comprehensive insurance model contains solutions to many of the problems plaguing the nation’s health care system.

“We have in our model already a lot of the efficiencies of care that people are talking about,” said Paul Genecin, the director of Yale University Health Services.

The plan, which provides coverage for 75 percent of Yale employees and approximately 50 percent of Yale undergraduates, is responsible for both the financial and delivery aspects of care. It is precisely this integration that most differentiates the Yale-run plan from the majority of other health plans, said Stephanie Spangler, the deputy provost for biomedical and health affairs.

In contrast to other private insurance plans, which only handle the payment and authorization of care, the Yale plan assembles the physicians and pays the bills of its members for both in-patient and out-patient care.

“Because you really have responsibility for all the care for all the patients for a whole population, [the Yale plan is] able, at lower cost, to provide more benefits,” Spangler said.

University President Richard Levin said Yale’s health plan has a much lower cost structure than private companies do. So, he said, he does not anticipate major changes to the type of coverage Yale provides for students and employees due to health care reform.

At Yale, all students are required to have health coverage, through either their parents or YUHS. Newly hired union employees are automatically enrolled in the University plan, and non-union employees have a choice between that plan, a private plan and going without insurance.

Still, renowned health care economist and Yale professor Howard Forman said the fact remains that the most uninsured group of individuals in the United States is recently graduated college students.

“We call [them] the ‘young invincibles,’ ” he said, “who are going out in the world and have jobs that do not provide health insurance and will have to go and actively acquire health insurance.”

He added that he does not believe the “young invincibles,” while they are in college, appreciate the risks they will face of being uninsured when they graduate, enter the workforce, and, “in all likelihood,” find the health insurance market difficult to navigate.

In Congress, the health care reform proposals currently on the table all call for cost control, primarily by strengthening medical providers’ relationships with insurance providers — an efficiency at work in the Yale plan — tort reform for medical malpractice suits, and increased primary care coverage.

Speaking last week, White House Director of Specialty Media Shin Inouye said that under a reformed system students would likely receive the same benefits as other Americans under a reformed system.

Still, students have unique needs that need to be dealt with in whatever national health care bill ultimately comes to a vote, said Jim Mitchell, the spokesman for the Lookout Mountain Group, a grass-roots coalition of college health care professionals.

“None of the bills under consideration in Congress really address specifically the issues facing college students,” Mitchell said. “They are lumping college students together with all 18- to 30-year-olds, who are most likely to be uninsured.”

Mitchell noted that while many universities and colleges already run highly efficient health care systems for students, they have an advantage because their core clientele are less costly because they are young and tend to be healthier than the general population.